Topic: Diet and Health

Latest recommendations for healthy dietary patterns include eggs

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Latest recommendations for healthy dietary patterns include eggs

Jen Houchins, PHD, RD

July 26, 2023

Heart Health

Nutritious Dietary Patterns

Key Takeaways:  
  • The American Heart Association (AHA) recently evaluated several popular diets and found that a few align with their previously outlined criteria for heart healthy diets, including: the DASH diet, Mediterranean diet, Pescatarian diet, and Vegetarian diet. 
  • The AHA also recommends that eggs can be consumed as part of heart healthy diet patterns in order to meet essential nutrient needs. 
  • More restrictive diets, such as very low-fat diet, low-carb diet, paleo diet and keto diet, were found to not align with the AHA’s heart healthy diet guidance, since these diets often restrict the consumption of nutrient-rich foods that are critical for heart health and overall health. 

While nutrient needs can be met by consuming various dietary patterns that align with personal, cultural, and budgetary preferences, there is a proliferation of nutrition misinformation that can make healthy eating confusing. Guidance from credible organizations, such as the American Heart Association (AHA), can help to clear up nutrition misinformation and put it into perspective. Recently, the American Heart Association (AHA) released a Scientific Statement evaluating current popular dietary patterns and found that several patterns strongly aligned with heart healthy diets1. Of importance, the AHA also recommends that eggs can be consumed as part of healthy dietary patterns in order to meet essential nutrient needs2. 

In their new Scientific Statement, the AHA evaluated popular dietary patterns with previously outlined criteria for heart-healthy diets3.  Multiple dietary patterns are well aligned with AHA Dietary Guidance, including Dietary Approaches to Stop Hypertension (DASH), Mediterranean, pescetarian, and vegetarian (ovo, lacto, ovo/lacto).  These diets are rich in vegetables, fruits, whole grains, and plant-protein sources.  The next tier of dietary patterns includes vegan and low-fat diets, which scored lower in AHA’s evaluation because there is a risk of nutrient inadequacy (e.g., vitamin B12) and potentially higher consumption of certain packaged foods with little nutritional value.  The lowest tier dietary patterns, including very low-fat, low-carbohydrate, paleo, and ketogenic diets, do not align with AHA Dietary Guidance.  These dietary patterns restrict the consumption of nutrient-rich foods that are critical for heart and overall health.  AHA indicates there are healthier ways to follow all of the popular dietary patterns, and outlines opportunities to address potential challenges.

Egg-specific research also supports that eggs consumed within healthy dietary patterns is beneficial for populations who are at risk for cardiovascular disease, for example, people who have elevated blood glucose or diabetes.  A new study from Boston University found that dietary patterns that included eggs and higher amounts of fiber, fish and whole grains resulted in a 26-29% reduction in the risk of impaired fasting blood glucose or type 2 diabetes4.  Another study from the University of Connecticut studied people with Metabolic Syndrome and found that “…consuming whole eggs in combination with a plant-based diet offers a healthier dietary pattern when compared to eggs substitutes by favorably affecting plasma lipids and antioxidant carotenoids, as well as choline, thereby reducing disease risk5.”

While the data continue to support a focus on the overall diet in order to reduce the risk of chronic disease1,6, it is important that nutrient needs are met.  For example, it is difficult to reach the adequate intake for choline without consuming eggs or taking a dietary supplement7.  As the AHA called out in the new Scientific Statement, there are challenges even with dietary patterns that align with heart-healthy recommendations and health professionals play a key role in guiding consumers toward healthier, more balanced diets adequate in all essential nutrients.  As a nutrient-dense food with high-quality protein, eggs are an excellent addition to the healthy dietary patterns recommended within the Dietary Guidelines for Americans and the AHA.

For recipe inspiration check out these recipes that fit into a heart-healthy diet.  

  1. Gardner, C.D., et al., Popular Dietary Patterns: Alignment With American Heart Association 2021 Dietary Guidance: A Scientific Statement From the American Heart Association. Circulation, 2023.

  2. Carson, J.A.S., et al., Dietary Cholesterol and Cardiovascular Risk: A Science Advisory From the American Heart Association. Circulation, 2019: p. Cir0000000000000743.

  3. Lichtenstein, A.H., et al., 2021 Dietary Guidance to Improve Cardiovascular Health: A Scientific Statement From the American Heart Association. Circulation, 2021: p. Cir0000000000001031.

  4. Mott, M.M., et al., Egg Intake Is Associated with Lower Risks of Impaired Fasting Glucose and High Blood Pressure in Framingham Offspring Study Adults. Nutrients, 2023. 15(3).

  5. Thomas, M.S., et al., Eggs Improve Plasma Biomarkers in Patients with Metabolic Syndrome Following a Plant-Based Diet-A Randomized Crossover Study. Nutrients, 2022. 14(10).

  6. U.S. Department of Health and Human Services and U.S. Department of Agriculture. 2020-2025 Dietary Guidelines for Americans. 2020; Available from: https://www.dietaryguidelines.gov/sites/default/files/2020-12/Dietary_Guidelines_for_Americans_2020-2025.pdf.

  7. Wallace, T.C. and V.L. Fulgoni, Usual Choline Intakes Are Associated with Egg and Protein Food Consumption in the United States. Nutrients, 2017. 9(8).

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More data support eggs as part of healthy diet patterns for people at risk for diabetes and cardiovascular disease

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More data support eggs

as part of healthy diet patterns for people at risk for diabetes and cardiovascular disease

JEN HOUCHINS, PHD, RD

June 22, 2023

Cardiometabolic Health

Nutritious Dietary Patterns

Key Takeaways:

According to new research from Boston University:

  • The conflicting results around the association of egg consumption and cardiovascular risk factors, such as high blood pressure and impaired fasting glucose, may be due to the dietary patterns accompanying egg consumption rather than the consumption of eggs itself.
  • Eating ≥5 eggs per week was associated with lower fasting glucose and systolic blood pressure after four years of follow-up.
  • Higher egg intake was linked to a lower risk of developing impaired fasting glucose, type 2 diabetes, and high blood pressure in this healthy population.

Eggs are recommended as part of healthy dietary patterns by the Dietary Guidelines for Americans1 and the American Heart Association2.  However, research gaps remain around egg consumption for certain groups who are at higher risk for cardiovascular disease.  A growing body of evidence indicates that eggs are an important part of the diet, even for those at risk of cardiovascular disease, within the context of a healthy dietary pattern3-7.  The association between egg consumption and cardiovascular risk factors such as high blood pressure and impaired fasting glucose is a research area that has had conflicting results, but new research suggests that “…variable dietary patterns that accompany egg intake may be responsible for the observed differences…8.”  For health professionals, this is great news, because there are many ways to make egg-containing meals and snacks more nutritious.

A new study from Boston University evaluated the association between egg consumption and blood pressure, impaired fasting glucose, or type 2 diabetes using data from the Framingham Offspring Study.  These data show that eating ≥5 eggs per week was associated with lower fasting glucose and systolic blood pressure after four years of follow-up.  Higher egg intake was linked to a lower risk of developing impaired fasting glucose, type 2 diabetes, and high blood pressure in this healthy population8. 

Of particular interest, the beneficial impact of eating eggs was stronger when part of healthy dietary patterns.  Specifically, dietary patterns that included eggs and higher amounts of fiber, fish, and whole grains resulted in a 26-29% reduction in the risk of impaired fasting blood glucose or type 2 diabetes8.

These observations are consistent with previous human intervention data that show that including eggs in the context of a plant-based diet does not adversely impact markers of cardiovascular health, and improved intakes of selenium and choline (eggs are an excellent source) in adults at risk for type 2 diabetes mellitus3.  The authors of this paper suggest, “Eggs could be used as an adjuvant to enhance plant-based diets that are typically recommended for those at risk of type 2 diabetes mellitus.”

The beneficial impact of egg consumption on blood glucose-related outcomes may be related to several factors.  Eggs may serve as a substitute for carbohydrates, they are a bioavailable food source of lutein and zeaxanthin, and they are a natural food source of vitamin D (6% DV), which may play a role in glucose metabolism8.  Collectively, these data support that “…moderate amounts of eggs may reduce the risk of impaired fasting glucose, type 2 diabetes, or high blood pressure when consumed as part of a healthy eating pattern8.”

Healthy eating patterns include a variety of vegetables, fruits (especially whole fruit), grains (at least half of which are whole grains), dairy foods, protein foods, and oils.  Healthy dietary patterns also limit foods higher in added sugars, saturated fat, and sodium1.  As a nutrient-rich food, eggs can fit into many different types of cuisines and accommodate personal preferences.  For recipe ideas that fit into these guidelines, please see our collection of recipes developed by credentialed health professionals.

  1. U.S. Department of Health and Human Services and U.S. Department of Agriculture. 2020-2025 Dietary Guidelines for Americans. 2020; Available from: https://www.dietaryguidelines.gov/sites/default/files/2020-12/Dietary_Guidelines_for_Americans_2020-2025.pdf.
  2. Carson, J.A.S., et al., Dietary Cholesterol and Cardiovascular Risk: A Science Advisory From the American Heart Association. Circulation, 2019: p. Cir0000000000000743.
  3. Njike, V.Y., et al., Egg Consumption in the Context of Plant-Based Diets and Cardiometabolic Risk Factors in Adults at Risk of Type 2 Diabetes. J Nutr, 2021.
  4. Sawrey-Kubicek, L., et al., Whole egg consumption compared with yolk-free egg increases the cholesterol efflux capacity of high-density lipoproteins in overweight, postmenopausal women. Am J Clin Nutr, 2019.
  5. Thomas, M.S., et al., Eggs Improve Plasma Biomarkers in Patients with Metabolic Syndrome Following a Plant-Based Diet-A Randomized Crossover Study. Nutrients, 2022. 14(10).
  6. DiBella, M., et al., Choline Intake as Supplement or as a Component of Eggs Increases Plasma Choline and Reduces Interleukin-6 without Modifying Plasma Cholesterol in Participants with Metabolic Syndrome.Nutrients, 2020. 12(10).
  7. Wu, F., et al., Egg and Dietary Cholesterol Consumption and Mortality Among Hypertensive Patients: Results From a Population-Based Nationwide Study. Frontiers in Nutrition, 2021. 8(830).
  8. Mott, M.M., et al., Egg Intake Is Associated with Lower Risks of Impaired Fasting Glucose and High Blood Pressure in Framingham Offspring Study Adults. Nutrients, 2023. 15 (3).

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New Research: Eggs can Help Address Malnutrition in U.S. Children

New Research: Eggs can Help Address Malnutrition in U.S. Children

Jen Houchins, PhD, RD

November 14, 2018

Nutrition

Key Takeaways:

  • Eggs can play an important role during early life to help address malnutrition – including undernutrition, overweight, obesity and inadequate consumption of vitamins and minerals – among U.S. children
  • Earlier introduction of eggs is linked with lower adiposity measures in early adolescent females and is also associated with a reduced risk of stunting in U.S. children.
  • Including eggs in the diets of U.S. children and adolescents are a valuable source of many nutrients that are often under-consumed, such as vitamin D, vitamin A, protein and choline.

Malnutrition can appear in different forms, including undernutrition (wasting, stunting, underweight), inadequate consumption of vitamins and minerals, overweight, obesity, and resulting diet-related chronic diseases.1  Childhood obesity is a significant health problem in the United States, with 1 in 5 children and adolescents affected.2  On the other hand, the overall prevalence of stunting (low height-for-age) and wasting (low weight-for-age) in the U.S. is low when compared to the rest of the world, at 2.9% and 0.2%, respectively, among American children under five years of age,3,4  However, stunting prevalence is higher among Hispanic children aged 2-19 years (6.1%) as compared to Non-Hispanic White children (2.6%).3,5  New data from State University of New York at Buffalo indicate eggs can play an important role during early life to help address multiple forms of malnutrition among U.S. children.

An investigation of data from mother-child pairs in Project Viva, a U.S. observational study (1999-2002) found that introducing eggs to infants by 12 months is linked to lower measures of adiposity in early adolescent (12-13 year old) females.6  These associations were not observed for males, and no associations were found between age of egg introduction and risk of obesity in males or females.  The authors report, “The underlying reasons and potential long-term implications for this seemingly contrasting sex response is unclear, however, it is known that the deposition pattern and function of adipose tissue differs between males and females.6” 

The same research team found a benefit for early introduction of eggs to reduce the risk of stunting.  In an analysis of the Infant Feeding Practices Study II, later introduction of eggs was associated with a lower mean weight-for-height (length) z-score among female infants at 12 months.  Later introduction of eggs was also linked with a lower average height-for-age z-score and higher risk of stunting in the follow-up of 6-year-old children.3  These data are consistent with a previous analysis of U.S. children (NHANES 2001-2012) that found egg consumption in infants is associated with longer recumbent length when compared to infants who do not consume eggs.7

Besides growth, inadequate consumption of select nutrients is common among U.S. children and adolescents. Calcium, vitamin D, potassium, and dietary fiber are nutrients of public health concern.  Vitamin A, vitamin C, vitamin E, vitamin K, magnesium, and choline are also under-consumed, and on average, adolescent girls do not get enough protein.8,9 Eggs provide a meaningful amount of vitamin D (6% Daily Value (DV)), vitamin A (8% DV), protein (12% DV), and choline (25% DV).  Eggs are a particularly valuable food source of choline for Americans, with egg consumers having almost double the choline intake of non-consumers7,10,11, and “…it is extremely difficult to achieve the Adequate Intake for choline without consuming eggs or taking a dietary supplement.10”

Early life is a critical period of time for both neurocognitive development and physical growth.9 While the value of eggs and the nutrients in eggs for early life nutrition and neurocognitive development has been a highlight of recent egg-related research,12,13 eating eggs early in life may also support healthy physical growth.  Overall, these new data suggest a potential advantage of including eggs as part of early complementary feeding to address different forms of malnutrition that are observed in U.S. children.

  1. World Health Organization. Malnutrition. 2021; Available from: https://www.who.int/news-room/fact-sheets/detail/malnutrition.

  2. Centers for Disease Control and Prevention. Childhood Overweight & Obesity. 2022; Available from: https://www.cdc.gov/obesity/childhood/index.html.

  3. Mi, B., et al., Infant age at egg introduction and malnutrition-related child growth in the United States. Matern Child Nutr, 2022. 18(4): p. e13390.

  4. UNICEF. Malnutrition in children. 2021; Available from: https://data.unicef.org/topic/nutrition/malnutrition/.

  5. Iriart, C., et al., Obesity and malnutrition among Hispanic children in the United States: double burden on health inequities. Rev Panam Salud Publica, 2013. 34(4): p. 235-43.

  6. Choudhary, D., et al., Egg Introduction during Infancy is Associated with Lower Fat Mass Index in Females at Early Adolescence. The Journal of Nutrition, 2022.

  7. Papanikolaou, Y. and V.L. Fulgoni, 3rd, Egg Consumption in Infants is Associated with Longer Recumbent Length and Greater Intake of Several Nutrients Essential in Growth and Development. Nutrients, 2018. 10(6).

  8. Dietary Guidelines Advisory Committee. Scientific Report of the 2020 Dietary Guidelines Advisory Committee: Advisory Report to the Secretary of Agriculture and the Secretary of Health and Human Services. 2020; Available from: https://www.dietaryguidelines.gov/sites/default/files/2020-07/ScientificReport_of_the_2020DietaryGuidelinesAdvisoryCommittee_first-print.pdf.

  9. U.S. Department of Health and Human Services and U.S. Department of Agriculture. 2020-2025 Dietary Guidelines for Americans. 2020; Available from: https://www.dietaryguidelines.gov/sites/default/files/2020-12/Dietary_Guidelines_for_Americans_2020-2025.pdf.

  10. Wallace, T.C. and V.L. Fulgoni, Usual Choline Intakes Are Associated with Egg and Protein Food Consumption in the United States. Nutrients, 2017. 9(8).

  11. Papanikolaou, Y. and V.L. Fulgoni, 3rd, Egg Consumption in U.S. Children is Associated with Greater Daily Nutrient Intakes, including Protein, Lutein + Zeaxanthin, Choline, alpha-Linolenic Acid, and Docosahexanoic Acid. Nutrients, 2019. 11(5).

  12. Christifano, D.N., et al., Intake of eggs, choline, lutein, zeaxanthin, and DHA during pregnancy and their relationship to fetal neurodevelopment. Nutr Neurosci, 2022: p. 1-7.

  13. Wallace, T.C., A Comprehensive Review of Eggs, Choline, and Lutein on Cognition Across the Life-span. J Am Coll Nutr, 2018. 37(4): p. 269-285.

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Nutrients in eggs work together to support infant brain development

Nutrients in eggs work together to support infant brain development

Jen Houchins, PhD, RD

May 2, 2023

Cognition

Nutrients in Eggs

Key Takeaways:

  • Maternal intake of eggs and the nutrients found in eggs (choline, lutein/zeaxanthin, DHA) may have a synergistic association with fetal neurodevelopment, which suggests that eggs provide more nutritional value than just the sum of their parts.
  • Since brain development is most rapid between conception and 24 months, pregnant women should be encouraged to include eggs in their diets.

 

“Brain development is most rapid during the first 1,000 days, from conception to age 24 months, and adequate nutrition is critical for this process.  Key nutrients include fat (particularly long-chain polyunsaturated fatty acids…), protein, iron, iodine, zinc, copper, choline, and the B vitamins.”1 While there is significant evidence demonstrating a positive impact of single nutrients2,3 there are no studies that have investigated the interaction of nutrients on fetal brain development.  A new study published in Nutritional Neuroscience found that maternal intake of eggs and nutrients found in eggs (i.e., choline, lutein/zeaxanthin, and docosahexaenoic acid (DHA)) have synergistic associations with fetal neurodevelopment, suggesting eggs are more than the sum of its parts.

This recent study conducted at the University of Kansas Medical Center was a secondary analysis of a randomized controlled trial evaluating the effect of different doses of DHA on fetal and infant brain developmen4.  Dietary data were collected to evaluate egg and nutrient intake during pregnancy, and measures of fetal neurodevelopment were assessed at 32 and 36 weeks gestation.  A significant interaction between maternal choline intake and lutein/zeaxanthin intake and fetal brain maturation was found at both 32 and 36 weeks gestation.  The interaction between choline intake, lutein/zeaxanthin intake, and DHA predicted brain maturation at 36 weeks, which suggests a synergistic impact.  Maternal egg intake also predicted measures of fetal neurodevelopment at both 32 and 36 weeks.  The authors conclude that egg consumption should be encouraged among pregnant women.2

Similar results were found in a previous study at the University of North Carolina. In this study, higher human milk choline and lutein levels, as well as higher choline and DHA levels, were associated with better recognition memory in 6-month old infants.3 In this secondary analysis of a larger study with exclusively breastfed infants, the authors concluded, “interactions between human milk nutrients appear important in predicting infant cognition, and there may be a benefit to specific nutrient combinations.”

Eggs provide various amounts of all of the nutrients listed by the American Academy of Pediatrics as essential for brain growth,5 including 12% Daily Value (DV) of high quality protein, 6% DV for zinc, 4% DV for iron, 25% DV for choline, 6% DV for folate, 20% DV for iodine, 8% DV for vitamin A, 6% DV for vitamin D, 6% DV for vitamin B6, 20% DV for vitamin B12, 18 mg α-linolenic acid (ALA), 29 mg docosahexaenoic acid (DHA), as well as 252 mcg lutein + zeaxanthin.6  Overall, we know these nutrients are individually linked to brain health, but growing evidence suggests there can be important interactions among key nutrients.2,3,7  Intervention trials are needed to confirm findings for brain development, however, these new data support recommendations that include egg consumption by pregnant women and children.

For more information about the benefits of choline during pregnancy and beyond, check out this helpful handout about prenatal and infant health.

  1. Dietary Guidelines Advisory Committee. Scientific Report of the 2020 Dietary Guidelines Advisory Committee: Advisory Report to the Secretary of Agriculture and the Secretary of Health and Human Services. 2020; Available from: https://www.dietaryguidelines.gov/sites/default/files/2020-07/ScientificReport_of_the_2020DietaryGuidelinesAdvisoryCommittee_first-print.pdf.

  2. Christifano, D.N., et al., Intake of eggs, choline, lutein, zeaxanthin, and DHA during pregnancy and their relationship to fetal neurodevelopment. Nutr Neurosci, 2022: p. 1-7.

  3. Cheatham, C.L. and K.W. Sheppard, Synergistic Effects of Human Milk Nutrients in the Support of Infant Recognition Memory: An Observational Study. Nutrients, 2015. 7(11): p. 9079-95.

  4. Gustafson, K.M., et al., Prenatal docosahexaenoic acid effect on maternal-infant DHA-equilibrium and fetal neurodevelopment: a randomized clinical trial. Pediatr Res, 2022. 92(1): p. 255-264.

  5. Schwarzenberg, S.J. and M.K. Georgieff, Advocacy for Improving Nutrition in the First 1000 Days to Support Childhood Development and Adult Health. Pediatrics, 2018. 141(2).

  6. U.S. Department of Agriculture. FoodData Central SR Legacy — Egg, whole, raw, fresh. 2019 April 1, 2019; Available from: https://fdc.nal.usda.gov/fdc-app.html#/food-details/171287/nutrients.

  7. Klatt, K.C., et al., Prenatal choline supplementation improves biomarkers of maternal docosahexaenoic acid status among pregnant participants consuming supplemental DHA: a randomized controlled trial. Am J Clin Nutr, 2022.

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Three Different Ways to Think About the Nutrients in Eggs

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Three Different Ways to Think About the Nutrients in Eggs

JEN HOUCHINS, PHD, RD

March 17, 2023

Nutrition

Nutrients in Eggs

Eggs are a nutrient-dense food recommended by the Dietary Guidelines for Americans (DGA), and there are a few ways to think about the nutrients in eggs:

  • The nutrients contained in an egg
  • The nutrients eggs provide within the American diet
  • Eggs as part of recommended dietary patterns

It is a combination of these three perspectives that gives us a complete story for the value of eggs in human nutrition.

Eggs are a nutrient-dense food

The Nutrition Facts Label highlights the value of eggs as part of healthy diet patterns, providing a good or excellent source of eight essential nutrients: 12% Daily Value (DV) of high quality protein; 15% DV of riboflavin (B2); 20% DV of vitamin B12; 35% DV of biotin (B7); 15% DV of pantothenic acid (B5); 20% DV of iodine; 25% DV of selenium; and 25% DV of choline.  These are the nutrients contained in an egg that, from a human nutrition perspective, are present in meaningful amounts.

Eggs provide key nutrients within the American diet

Another way to look at the nutritional value of eggs is with national data of what Americans actually eat (What We Eat in America, which is part of the National Health and Nutrition Examination Survey (NHANES)).  The NHANES is an ongoing nationally representative cross-sectional analysis of the U.S. population that allows evaluation of typical dietary habits, including the nutrient contribution of eggs. 

The NHANES 2015-2018 data show that, on average, eggs contribute 25% of the essential fatty acid docosahexaenoic acid (DHA) to the diet, 22% of the choline, 12% of the vitamin D, 8% of the lutein + zeaxanthin, 8% of the selenium, 7% of the vitamin A, 6% of the riboflavin, 5% of the vitamin B12 and protein, among other nutrients, for Americans 19+ years of age.  For American children 2-18 years of age, eggs contribute an average of 37% of the DHA, 19% of the choline, 11% of the lutein + zeaxanthin, 6% of the vitamin D and selenium, and 5% of the vitamin A and riboflavin to the diet.  What’s interesting is that while eggs have small amounts of the omega-3 fatty acid DHA (~29 mg), because they are so commonly consumed – they are in more than 94% of American households– they contribute to more than a quarter of the DHA intake of Americans, on average. And although higher levels of DHA can be found in fish and seafood, eggs contribute a higher percentage of DHA because Americans do not consume very much fish and seafood.

Eggs fit into healthy dietary patterns

Finally, eggs can be viewed as an important component of healthy dietary patterns, identified as a nutrient-dense food by the DGA: “Vegetables, fruits, whole grains, seafood, eggs, beans, peas, and lentils, unsalted nuts and seeds, fat-free and low-fat dairy products, and lean meats and poultry—when prepared with no or little added sugars, saturated fat, and sodium—are nutrient-dense foods.”  The DGA recommends eggs across the lifespan as part of example dietary patterns, including the U.S.-Style Dietary Pattern, the Healthy Vegetarian Dietary Pattern, and the Healthy Mediterranean-Style Dietary Pattern.  Similarly, the American Heart Association has highlighted the value of eggs as part of healthy dietary patterns across the lifespan.

Overall, there are multiple ways to think of the nutritional value of an egg.  These different perspectives continue to build a story of the nutrient contribution of eggs across the lifespan, from babies to older adults!

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New research further supports early introduction of eggs

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New research further supports early introduction of eggs

JEN HOUCHINS, PHD, RD

March 9, 2023

A growing body of evidence supports early introduction of potentially allergenic foods to reduce the risk of allergy to these foods1-4.  In fact, professional medical associations recommend cooked egg around 4-6 months to reduce the risk of allergy to egg5,6.  However, more research is needed to evaluate the frequency, amount, and form of egg in relation to the development of immune tolerance.  New research from State University of New York at Buffalo is helping to answer the questions about timing and frequency of egg consumption during infancy7.

The investigators conducted an analysis of data from the 2005-2007 Infant Feeding Practices Study II, a national study that followed mothers from late pregnancy through their infant’s first year of life and then collected data at 6 years of age. Infants who consumed eggs two or more times per week at 12 months had a lower risk of maternal-reported egg allergy at 6 years compared to babies who consumed eggs less than two times per week or none at all7.

The same research team published data from Project Viva, a U.S. observational study (1999-2002), and found that infants with delayed introduction of eggs after 12 months had an increased risk of egg allergy at both 2 and 12 years of age8.  This observation aligns with recommendations for early introduction, including the Dietary Guidelines for Americans: “Potentially allergenic foods (e.g., peanuts, egg, cow milk products, tree nuts, wheat, crustacean shellfish, fish, and soy) should be introduced when other complementary foods are introduced to an infant’s diet2.”

Introduction of eggs into an infant’s diet has the added benefit that eggs provide various amounts of all the nutrients listed by the American Academy of Pediatrics as essential for brain growth9.  Eggs also provide 252 mcg of lutein + zeaxanthin10, carotenoids with emerging evidence linking to brain development and health11,12.

More research is needed regarding the optimal amount and form of egg to reduce the risk of egg allergy.  However, guidelines around the world are quite consistent in recommending well-cooked eggs in an amount and form that aligns with the baby’s readiness and ability to eat3,4.  Well-cooked egg mashed with pureed foods or chopped and served as finger food can be offered to infants when developmentally ready after 4-6 months of age3.  For more detail on introducing eggs into an infant’s diet, please see Egg Nutrition Center’s One Bite At A Time Feeding Guide and The What, When, and How of Reducing Food Allergy Risk: A Health Practitioners’ Guide. For recipe inspiration check out Avocado Egg Toast, Vegetable Egg Roll Up and Banana Pumpkin Pancakes.

  1. Dietary Guidelines Advisory Committee. Scientific Report of the 2020 Dietary Guidelines Advisory Committee: Advisory Report to the Secretary of Agriculture and the Secretary of Health and Human Services. 2020; Available from: https://www.dietaryguidelines.gov/sites/default/files/2020-07/ScientificReport_of_the_2020DietaryGuidelinesAdvisoryCommittee_first-print.pdf.
  2. U.S. Department of Health and Human Services and U.S. Department of Agriculture. 2020-2025 Dietary Guidelines for Americans. 2020; Available from: https://www.dietaryguidelines.gov/sites/default/files/2020-12/Dietary_Guidelines_for_Americans_2020-2025.pdf.
  3. Schroer, B., et al., Practical Challenges and Considerations for Early Introduction of Potential Food Allergens for Prevention of Food Allergy. J Allergy Clin Immunol Pract, 2021. 9(1): p. 44-56.e1.
  4. Caffarelli, C., et al., Egg Allergy in Children and Weaning Diet. Nutrients, 2022. 14(8).
  5. Fleischer, D.M., et al., A Consensus Approach to the Primary Prevention of Food Allergy Through Nutrition: Guidance from the American Academy of Allergy, Asthma, and Immunology; American College of Allergy, Asthma, and Immunology; and the Canadian Society for Allergy and Clinical Immunology. The Journal of Allergy and Clinical Immunology: In Practice, 2021. 9(1): p. 22-43.e4.
  6. Halken, S., et al., EAACI guideline: Preventing the development of food allergy in infants and young children (2020 update). Pediatr Allergy Immunol, 2021. 32(5): p. 843-858.
  7. Wen, X., et al., Frequency of Infant Egg Consumption and Risk of Maternal-Reported Egg Allergy at 6 Years.The Journal of Nutrition, 2022.
  8. Martone, G.M., et al., Delayed egg introduction beyond infancy and increased egg allergy risk in childhood. J Paediatr Child Health, 2022.
  9. Schwarzenberg, S.J. and M.K. Georgieff, Advocacy for Improving Nutrition in the First 1000 Days to Support Childhood Development and Adult Health. Pediatrics, 2018. 141(2).
  10. U.S. Department of Agriculture. FoodData Central SR Legacy — Egg, whole, raw, fresh. 2019 April 1, 2019; Available from: https://fdc.nal.usda.gov/fdc-app.html#/food-details/171287/nutrients.
  11. Johnson, E.J., Role of lutein and zeaxanthin in visual and cognitive function throughout the lifespan. Nutr Rev, 2014. 72(9): p. 605-12.
  12. Wallace, T.C., A Comprehensive Review of Eggs, Choline, and Lutein on Cognition Across the Life-span. J Am Coll Nutr, 2018. 37(4): p. 269-285.

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The Evolution of Dietary Cholesterol Recommendations

The Evolution of Dietary Cholesterol Recommendations

JEN HOUCHINS, PHD, RD

February 2, 2023

Cardiometabolic Health

Nutritious Dietary Patterns

Eggs – a nutrient-dense food once misunderstood for fat and cholesterol content – are now considered a valuable part of healthy eating patterns. The Dietary Guidelines for Americans includes eggs in all three recommended healthy dietary patterns and in 2015 removed the previous recommendation to limit daily cholesterol intake to <300mg. What’s more, the American Heart Association now advises that healthy adults can include one egg daily in a heart-healthy diet.

How did that happen?

Because authoritative dietary guidance is developed based on the body of scientific evidence available at the time, it makes sense that dietary guidance toward eating for heart health has advanced as new research has improved our understanding. New recommendations around eggs and cholesterol are understandably a point of confusion for many consumers. Therefore, it is important for healthcare professionals to understand the history of recommendations and how guidance has evolved over time. Read on to learn more…

  • In the U.S., the first dietary cholesterol recommendations were issued in the 1960s and 1970s. In the 1960s, the recommendations to reduce dietary cholesterol stemmed from evidence in a few areas, including animal models demonstrating that dietary cholesterol can increase atherosclerosis.1 However, the concentration of cholesterol used in these studies was extremely high, providing no practical application for human diets. In addition, many early human studies led to prediction equations that estimate the impact of dietary cholesterol on total blood cholesterol in isolation. Because humans consume cholesterol as part of whole foods and meals, the practical application of this research to health outcomes is limited.
  • In 1968, the American Heart Association recommended consuming less than 300mg cholesterol per day and ≤3 eggs per week.
  • In 1977, the Dietary Goals for the United States similarly encouraged Americans to “reduce cholesterol consumption to about 300 mg/day.”2,3 While these were the best recommendations at the time, the details of these early reports indicate uncertainty around the impact of dietary cholesterol on heart disease. Nonetheless, the recommended 300 mg/day cholesterol limit became part of authoritative U.S. dietary guidance.
  • The Dietary Guidelines for Americans (DGAs), first published in 1980 and updated every five years, reflect an evolution of the science around dietary cholesterol. While the DGAs highlight the best available evidence at the time, there has been uncertainty reflected in the language used around specific topics, including dietary cholesterol, throughout the various DGA versions.
  • In 2013, after decades of research, the American Heart Association (AHA) and the American College of Cardiology (ACC) published a report on lifestyle management to reduce cardiovascular risk4. This report was an updated review of the science in which the authors concluded, “There is insufficient evidence to determine whether lowering dietary cholesterol reduces LDL-c.” A systematic review and meta-analysis cited in this report and published in the Journal of Clinical Nutrition concluded that egg consumption is not associated with cardiovascular disease or cardiac mortality risk in the general population.5
  • In alignment with the AHA/ACC report, the 2015 Dietary Guidelines for Americans removed the 300 mg/day cholesterol limit and placed a new focus on healthy dietary patterns. 6
  • In 2020, Harvard researchers analyzed up to 32 years of follow-up results from three observational studies and found that moderate egg consumption (defined as up to one egg per day), is not associated with cardiovascular disease risk overall. 7
  • The current 2020-2025 DGAs affirm that eggs are a nutrient-dense food and recommend egg consumption within the context of healthy dietary patterns. The Dietary Guidelines for Americans (DGA) are based on decades of data and nutrition research and will continue to be updated as we gain new insights from scientific research. The American Heart Association also includes eggs as part of healthy dietary patterns. 8,9

Try these recipes that fit into a heart-healthy diet.

 

Photo by Sara Haas, RDN.

  1. Fernandez ML, Murillo AG. Is There a Correlation between Dietary and Blood Cholesterol? Evidence from Epidemiological Data and Clinical Interventions.Nutrients. 2022; 14(10):2168. https://doi.org/10.3390/nu14102168
  2. Grundy, S.M., et al., Rationale of the diet-heart statement of the American Heart Association. Report of Nutrition Committee. Circulation, 1982. 65(4): p. 839a-854a.
  3. Select Committee on Nutrition and Human Needs. Dietary Goals for the United States, Second Edition. 1977; Available from: https://naldc.nal.usda.gov/download/1759572/PDF.
  4. Eckel, R.H., J.M. Jakicic, and et al. 2013 Report on Lifestyle Management to Reduce Cardiovascular Risk: Full Work Group Report Supplement. 2013; Available from: http://jaccjacc.cardiosource.com/acc_documents/2013_FPR_S5_Master_Lifestyle.pdf.
  5. Shin JY, Xun P, Nakamura Y, He K. Egg consumption in relation to risk of cardiovascular disease and diabetes: a systematic review and meta-analysis.Am J Clin Nutr. 2013;98(1):146-159. doi:10.3945/ajcn.112.051318
  6. S. Department of Health and Human Services and U.S. Department of Agriculture. 2015-2020 Dietary Guidelines for Americans. 2015; 8:[Available from: http://health.gov/dietaryguidelines/2015/guidelines/].
  7. Drouin-Chartier JP, Chen S, Li Y, et al. Egg consumption and risk of cardiovascular disease: three large prospective US cohort studies, systematic review, and updated meta-analysis.BMJ. 2020;368:m513. Published 2020 Mar 4. doi:10.1136/bmj.m513
  8. Carson, J.A.S., et al., Dietary Cholesterol and Cardiovascular Risk: A Science Advisory From the American Heart Association. Circulation, 2019: p. Cir0000000000000743.
  9. S. Department of Health and Human Services and U.S. Department of Agriculture. 2020-2025 Dietary Guidelines for Americans. 2020; Available from: https://www.dietaryguidelines.gov/sites/default/files/2020-12/Dietary_Guidelines_for_Americans_2020-2025.pdf.

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Eggs can be part of a heart-healthy diet

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Eggs can be part of a heart-healthy diet:

Information & Resources for Healthcare Professionals

Katie hayes, rdn

January 26, 2023

Cardiometabolic Health

Nutritious Dietary Patterns

Science on dietary cholesterol has evolved, but Americans remain confused. Contradicting information still exists in the media and online, despite the 2020 Dietary Guidelines for Americans and the latest research indicating that eggs can be included in a healthy diet. This is especially concerning because eggs are an affordable, accessible source of high-quality protein with many vitamins and minerals that support health at every life stage. Consumers trust healthcare professionals for nutrition information and guidance, and we want to help provide the most up-to-date, research-based information about consuming eggs.

In order to help Healthcare Professionals offer their patients and clients comprehensive information about egg’s role in a heart-healthy diet, we created an egg nutrition and heart health guide (download here) that can be printed and shared. Why is this information important to share with parents and caregivers? Keep reading! 

Including eggs in a heart-healthy diet is supported by recent research:

  • A 2020 Harvard School of Public Health meta-analysis of prospective cohort studies found that consumption of up to one egg per day is not associated with cardiovascular disease risk.1
  • A study published in the American Journal of Clinical Nutrition in 2020 concluded, “In 3 large international prospective studies including approximately 177,000 individuals…we did not find significant associations between egg intake and blood lipids, mortality, or major CVD events.”2
  • A 2013 systematic review and meta-analysis of almost 350,000 participants found no relationship between egg intake and cardiovascular disease, ischemic heart disease, or stroke.3

A Science Advisory from the American Heart Association (AHA) concluded:4  

  • Healthy individuals can include a whole egg daily in heart-healthy dietary patterns.
  • For older healthy individuals, given the nutritional benefits and convenience of eggs, consumption of up to two eggs per day is acceptable within the context of a heart-healthy diet.
  • Vegetarians who do not consume meat-based cholesterol-containing foods may include more eggs in their diets within the context of moderation.
  • While the AHA still places caution on dietary cholesterol for people who have dyslipidemia, a growing body of research indicates eggs can be included in heart-healthy dietary patterns even in people at risk for CVD.5,6,7

Back in 2015, the Dietary Guidelines for Americans stopped recommending restrictions on the amount of cholesterol in the food you eat.8,9 A recent article in the Journal of Family Practice Hot Topics in Primary Careconcludes, “More recent data suggest that eggs do not increase the risk for heart disease and should be considered a valuable component of a healthy diet.”10

The nutrient-rich and versatile egg is a complete protein with essential vitamins and minerals for healthy living.

One large egg packs a nutritious punch:10

  • 70 calories
  • 6g high-quality protein
  • 1g polyunsaturated fat
  • 2g monounsaturated fat
  • Excellent source of vitamin B12, biotin, iodine, selenium, and choline plus a a good source of riboflavin, pantothenic acid, and protein
  • All 9 essential amino acids
  • 252 mcg lutein + zeaxanthin

Nearly half of an egg’s protein and most of its vitamins and minerals — including those essential for supporting our brains and bodies — are found in the yolk.

Include Eggs in Heart-Healthy Dietary Plans!

Eggs are a compact, natural source of vitamins and minerals to help keep you energized. They’re a good source of protein and contain nutrients that support brain health at every age and stage — all for just 70 calories per large egg.

For more information and shareable handouts, videos, and more visit our materials page. 

  1. Drouin-Chartier J.P., et al. BMJ, 2020;368:m513. Published online 2020 Mar 4.
  2. Dehghan M., et al. Am J Clin Nutr, 2020;111(4):795-803.
  3. Shin, J.Y., et al., Am J Clin Nutr, 2013. 98(1): p. 146-59.
  4. Carson JAS, et al. 2019;141(3):e39-e53.
  5. DiBella M., et al. Nutrients, 2020;12(10):3120
  6. Thomas M., et al. Nutrients, 2022;14(10):2138
  7. Njike, V., et al. J Nutrition, 2021;151:3651-60.
  8. USDA and HHS. Dietary Guidelines for Americans, 2015–2020. 8th Edition.
  9. USDA and HHS. Dietary Guidelines for Americans, 2020-2025. 9th Edition.
  10. Fernandez, M.L., Supplement to the Journal of Family Practice, 2022. 71(6): p. S71-S75.

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Eggs and Heart Health: A “hot topic” update for health professionals

Eggs and Heart Health: A “hot topic” update for health professionals

JEN HOUCHINS, PHD, RD

October 18, 2022

Cardiometabolic Health

Nutritious Dietary Patterns

In 2013, after decades of research, the American Heart Association and the American College of Cardiology published a new guideline on lifestyle management to reduce cardiovascular risk which concluded, “There is insufficient evidence to determine whether lowering dietary cholesterol reduces LDL-cholesterol1.”  This was followed by the removal of the 300 mg per day cholesterol restriction within the 2015 Dietary Guidelines for Americans and a greater focus on overall healthy dietary patterns2.  Today, eggs are recommended as part of heathy eating patterns by both the Dietary Guidelines for Americans and the American Heart Association3,4.  Yet, many people, including health professionals, remain concerned about dietary cholesterol5.

In a new article published in Hot Topics in Primary Care, a special supplement to the Journal of Family Practice, Dr. Maria Luz Fernandez highlights recent research around eggs and cardiovascular health and highlights the evolution of science around the impact of dietary cholesterol on blood cholesterol6.  While the science is clear that elevated LDL-cholesterol increases the risk for cardiovascular disease, the impact of dietary cholesterol and egg intake is not straightforward.  For most people, egg consumption does not impact blood cholesterol levels.  For those whose blood cholesterol responds to dietary cholesterol, generally there is an increase in both LDL-cholesterol and HDL-cholesterol, leaving the ratio between the two unchanged. The ratio of LDL to HDL is recognized as an important indicator of cardiovascular disease risk7.

Further, if there is a change in blood cholesterol secondary to egg consumption, the lipoproteins generated tend to be large, less atherogenic LDL particles that are “preferentially removed by [the] liver rather than by endothelial cells.”  The HDL particles generated secondary to egg consumption have improved functionality and a larger surface area which can transport a higher concentration of carotenoids6.  Overall, these exciting data illustrate that science has moved far beyond looking at the impact of isolated dietary cholesterol on total blood cholesterol, and instead, we are now evaluating the impact of foods (i.e.eggs) on health outcomes.

Most recent publications demonstrate egg consumption is not associated with cardiovascular disease risk8-10, and that is the basis for current guidelines that recommend eggs across the lifespan.  It is important to recognize the benefits of eggs within the diet and their role in optimizing health.  Dr. Fernandez lists several protective effects of eggs6:

  • Generation of HDL-cholesterol with improved function11,12
  • Highly bioavailable lutein and zeaxanthin, carotenoids known to accumulate in the eye and reduce risk of age-related macular degeneration13
  • An excellent source of choline, which is essential for brain health
  • High quality protein for maintenance of health

While the American Heart Association identifies a research gap for people who have abnormal blood lipids4, a growing body of evidence demonstrates eggs can be beneficial even for people at risk of cardiovascular disease11,14,15.  Of course, an overall healthy diet pattern is essential for maintenance of health3,4. For meal inspiration, check out our collection of heart-healthy recipes.

 

Photo by Sara Haas, RDN.

  1. Eckel, R.H., et al., 2013 AHA/ACC guideline on lifestyle management to reduce cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation, 2014. 129(25 Suppl 2): p. S76-99.

  2. U.S. Department of Health and Human Services and U.S. Department of Agriculture. 2015-2020 Dietary Guidelines for Americans. 2015; 8:[Available from: http://health.gov/dietaryguidelines/2015/guidelines/].

  3. U.S. Department of Health and Human Services and U.S. Department of Agriculture. 2020-2025 Dietary Guidelines for Americans. 2020; Available from: https://www.dietaryguidelines.gov/sites/default/files/2020-12/Dietary_Guidelines_for_Americans_2020-2025.pdf.

  4. Carson, J.A.S., et al., Dietary Cholesterol and Cardiovascular Risk: A Science Advisory From the American Heart Association. Circulation, 2019: p. Cir0000000000000743.

  5. Ipsos, American Egg Board Nutrition Messaging Project. 2021.

  6. Fernandez, M.L., The Role of Eggs in Healthy Diets. Supplement to the Journal of Family Practice, 2022. 71(6): p. S71-S75.

  7. Blesso, C.N. and M.L. Fernandez, Dietary Cholesterol, Serum Lipids, and Heart Disease: Are Eggs Working for or Against You? Nutrients, 2018. 10(4).

  8. Drouin-Chartier, J.P., et al., Egg consumption and risk of cardiovascular disease: three large prospective US cohort studies, systematic review, and updated meta-analysis. Bmj, 2020. 368: p. m513.

  9. Dehghan, M., et al., Association of egg intake with blood lipids, cardiovascular disease, and mortality in 177,000 people in 50 countries. Am J Clin Nutr, 2020.

  10. Shin, J.Y., et al., Egg consumption in relation to risk of cardiovascular disease and diabetes: a systematic review and meta-analysis. Am J Clin Nutr, 2013. 98(1): p. 146-59.

  11. Sawrey-Kubicek, L., et al., Whole egg consumption compared with yolk-free egg increases the cholesterol efflux capacity of high-density lipoproteins in overweight, postmenopausal women. Am J Clin Nutr, 2019.

  12. Andersen, C.J., et al., Egg consumption modulates HDL lipid composition and increases the cholesterol-accepting capacity of serum in metabolic syndrome. Lipids, 2013. 48(6): p. 557-67.

  13. Johnson, E.J., Role of lutein and zeaxanthin in visual and cognitive function throughout the lifespan. Nutr Rev, 2014. 72(9): p. 605-12.

  14. Njike, V.Y., et al., Egg Consumption in the Context of Plant-Based Diets and Cardiometabolic Risk Factors in Adults at Risk of Type 2 Diabetes. The Journal of Nutrition, 2021. 151(12): p. 3651-3660.

  15. Thomas, M.S., et al., Eggs Improve Plasma Biomarkers in Patients with Metabolic Syndrome Following a Plant-Based Diet-A Randomized Crossover Study.
    Nutrients, 2022.14(10).

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